Provider Demographics
NPI:1275684318
Name:BUSCH, JEREMY DANIEL (DC)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:DANIEL
Last Name:BUSCH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 N ROYAL AVE
Mailing Address - Street 2:
Mailing Address - City:FRONT ROYAL
Mailing Address - State:VA
Mailing Address - Zip Code:22630-3526
Mailing Address - Country:US
Mailing Address - Phone:540-635-4440
Mailing Address - Fax:540-635-4450
Practice Address - Street 1:1100 N ROYAL AVE
Practice Address - Street 2:
Practice Address - City:FRONT ROYAL
Practice Address - State:VA
Practice Address - Zip Code:22630-3526
Practice Address - Country:US
Practice Address - Phone:540-635-4440
Practice Address - Fax:540-635-4450
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556516111N00000X
MI2301009363111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor